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General NPI Number Information
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NPI Number | 1215507876
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Entity Type | Individual
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Provider Name | GAIGE FLEWELLING CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | 140 ACADEMY ST
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-3102
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Country | US
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Telephone | 207-768-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 70 GRIFFIN RIDGE RD
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City | MAPLETON
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State | ME
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Zip | 04757-4401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN66205
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RNA213054
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License Number State | ME
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